Spine Journal最新文献

{"title":"Comparison between atlantoaxial and occipitocervical fusion: clinical implications of restoring the atlanto-occipital joint.","authors":"Dong-Ho Lee, Sung Tan Cho, Hyun Wook Kang, Sehan Park, Chang Ju Hwang, Jae Hwan Cho","doi":"10.1016/j.spinee.2024.11.002","DOIUrl":"10.1016/j.spinee.2024.11.002","url":null,"abstract":"<p><strong>Background context: </strong>Cervical myelopathy originating from high cervical pathology is typically managed through stabilization constructs, with the most common options being atlantoaxial fusion (AAF) and occipitocervical fusion (OCF). However, a well-established comparison of the 2 techniques in terms of clinical and radiological outcomes has not been made.</p><p><strong>Purpose: </strong>Compare the surgical outcomes of AAF and OCF with a minimum follow-up period of 2 years.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 64 patients who underwent AAF (n=46) and OCF (n=18) to treat cervical myelopathy were retrospectively reviewed.</p><p><strong>Outcome measure: </strong>Neck pain Visual Analogue Scale (VAS), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores and postoperative complications were assessed as clinical outcomes. For the radiological outcomes, cervical sagittal parameters including C0-2 lordosis, C2-7 lordosis, C0-7 lordosis, neck range of motion (ROM), C2-7 sagittal vertical axis, C2 sagittal tilt, T1 slope, chin brow vertical angle and McGregor slope were evaluated.</p><p><strong>Methods: </strong>Continuous variables between AAF and OCF were compared using either the Mann-Whitney U test or an independent T-test. The Wilcoxon signed-rank test was utilized to compare variables across preoperative, 1-month postoperative, and final follow-up periods.</p><p><strong>Results: </strong>Both the AAF and OCF groups did not show any significant differences in the total NDI score, VAS for neck pain, and JOA score when comparing preoperative and postoperative evaluations. However, at 1 month postoperatively (AAF group, 2.63; OCF group, 8.00: p=.006) and final follow-ups (AAF group, 3.08; OCF group, 7.82: p=.003), the OCF group showed a significant decline in the lifting function compared to the AAF group. Furthermore, the decrease in neck ROM was significantly more severe in the OCF group compared to the AAF group (AAF group, -6.4°; OCF group, -20.1°: p=.010).</p><p><strong>Conclusions: </strong>The OCF has the potential to limit neck movement and impede lifting capabilities after the surgery. Hence, the AAF is advisable over the OCF, especially for younger individuals or those involved in strenuous physical work.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An in vivo three-dimensional kinematics study of the cervical vertebrae under physiological loads in patients with cervical spondylosis.","authors":"Yanlong Zhong, Fangming Zhan, Zizhen Zhang, Guoan Li, Shaobai Wang, Zongmiao Wan","doi":"10.1016/j.spinee.2024.11.001","DOIUrl":"10.1016/j.spinee.2024.11.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Studies of in vivo kinematic differences between healthy individuals and those with cervical spondylosis (CS) have been reported, but only movements under nonphysiological loads have been investigated. Differences in the in vivo, cervical kinematics between healthy individuals and those with CS are unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate the in vivo, cervical kinematics of patients with CS under physiological loads.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This was a retrospective, case-controlled study that used three-dimensional (3D) to 3D registration techniques combined with conical beam computed tomography (CBCT) to investigate the cervical kinematics of patients with CS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Twenty individuals diagnosed with CS were selected for study participation and matched with 20 participants who did not have CS and were in good health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Pfirrmann grading, intervertebral range of motion (ROM), kinematics and cross-sectional area of posterior neck muscles (CAPNM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All study participants underwent seven CBCT scans of their cervical vertebrae. The 3D segmental motion features of the vertebra in vivo were calculated using 3D-to-3D volume registration to overlay images of the vertebra at each functional position. The 3D range of motion (ROM) of each cervical segment was expressed with six degrees of freedom using Euler angles and translated onto a coordinate system. A kinematic subgroup analysis was conducted based on the severity of symptoms within the CS group, and differences in muscle volume between the CS and control groups were also evaluated. Project supported by the National Natural Science Foundation of China (Grant No. 81960408,82260445), Key Project of Jiangxi Provincial Natural Science Foundation (Grant No. 20242BAB26125), Clinical Cultivation Project of The First Affiliated Hospital of Nanchang University (Grant No. YFYLCYJPY 20220203).The authors declare no conflict of interest in preparing this article.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The CS group exhibited noticeable reductions in the primary rotational ROMs of left-right rotation at C4-C5, C5-C6, C6-C7, C4-C7, and C1-C7 compared to the controls. During left-right bending, there were no significant differences in the primary ROMs, coupled translations, or rotations between the two groups. However, compared to controls, the CS group had significantly lower primary ROMs for C4-C7, C1-C7 and C5-C6 during flexion-extension. During left-right rotation, the primary rotations and coupled lateral bending at C6-C7 were significantly increased in the mild CS group compared to the moderate CS group. In the mild CS group, the primary ROM of the C4-C5 and C5-C6 during flexion-extension was significantly greater than that of the moderate CS group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;For the first time, the in vivo 3D kinematics of the cervical spine","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI spine request form enhancement and auto protocoling using a secure institutional large language model.","authors":"James Thomas Patrick Decourcy Hallinan, Naomi Wenxin Leow, Wilson Ong, Aric Lee, Yi Xian Low, Matthew Ding Zhou Chan, Ganakirthana Kalpenya Devi, Daniel De-Liang Loh, Stephanie Shengjie He, Faimee Erwan Muhamat Nor, Desmond Shi Wei Lim, Ee Chin Teo, Xi Zhen Low, Shaheryar Mohammad Furqan, Wilson Wei Yang Tham, Jiong Hao Tan, Naresh Kumar, Andrew Makmur, Yonghan Ting","doi":"10.1016/j.spinee.2024.10.021","DOIUrl":"10.1016/j.spinee.2024.10.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Secure institutional large language models (LLM) could reduce the burden of noninterpretative tasks for radiologists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Assess the utility of a secure institutional LLM for MRI spine request form enhancement and auto-protocoling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective study conducted from December 2023 to February 2024, including patients with clinical entries accessible on the electronic medical record (EMR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Overall, 250 spine MRI request forms were analyzed from 218 patients (mean age = 55.9 years ± 18.9 [SD]; 108 women) across the cervical (n=56/250, 22.4%), thoracic (n=13/250, 5.2%), lumbar (n=166/250, 66.4%), and whole (n=15/250, 6.0%) spine. Of these, 60/250 (24.0%) required contrast and 41/250 (16.4%) had prior spine surgery/instrumentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Primary-Adequacy of clinical information on clinician and LLM-augmented request forms were rated using a four-point scale. Secondary-Correct MRI protocol suggestion by LLM and first-year board-certified radiologists (Rad4 and Rad5) compared to a consensus reference standard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A secured institutional LLM (Claude 2.0) used a majority decision prompt (out of six runs) to enhance clinical information on clinician request forms using the EMR, and suggest the appropriate MRI protocol. The adequacy of clinical information on the clinician and LLM-augmented request forms was rated by three musculoskeletal radiologists independently (Rad1:10-years-experience; Rad2:12-years-experience; Rad3:10-years-experience). The same radiologists provided a consensus reference standard for the correct protocol, which was compared to the protocol suggested by the LLM and two first-year board-certified radiologists (Rad4 and Rad5). Overall agreement (Fleiss kappas for inter-rater agreement or % agreement with the reference standard and respective 95%CIs) were provided where appropriate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;LLM-augmented forms were rated by Rads 1-3 as having adequate clinical information in 93.6-96.0% of cases compared to 46.8-58.8% of the clinician request forms (p&lt;0.01). Substantial interobserver agreement was observed with kappas of 0.71 (95% CI: 0.67-0.76) for original forms and 0.66 (95% CI: 0.61-0.72) for LLM-enhanced requests. Rads 1-3 showed almost perfect agreement on protocol decisions, with kappas of 0.99 (95% CI: 0.94-1.0) for spine region selection, 0.93 (95% CI: 0.86-1.0) for contrast necessity, and 0.93 (95% CI: 0.86-0.99) for recognition of prior spine surgery. Compared to the consensus reference standard, the LLM suggested the correct protocol in 78.4% (196/250, p&lt;0.01) of cases, albeit inferior to Rad4 (90.0%, p&lt;0.01) and Rad5 (89.2%, p&lt;0.01). The secure LLM did best in identifying spinal instrumentation in 39/41 (95.1%) cases, improved compared to Rad4 (61.0%) and Rad5 (41.5%) (both p&lt;0.01). The se","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond a ferroptosis inducer: erastin can suppress nutrient deprivation induced cell death in the intervertebral disc.","authors":"Jie Jin, Yu Chen, Ximiao Chen, Zengjie Zhang, Yaosen Wu, Naifeng Tian, Aimin Wu, Xiangyang Wang, Zhenxuan Shao, Yifei Zhou, Xiaolei Zhang, Yan Wu","doi":"10.1016/j.spinee.2024.10.018","DOIUrl":"10.1016/j.spinee.2024.10.018","url":null,"abstract":"<p><strong>Background: </strong>Erastin has been found to induce ferroptosis; however, whether erastin may have roles other than ferroptosis inducer in cells is unknown. Nutrient deficiency is one of the major causes of many diseases including intervertebral disc (IVD) degeneration.</p><p><strong>Purpose: </strong>The current study investigates the effect of erastin in nucleus pulposus cells under nutrient deprivation condition.</p><p><strong>Study design: </strong>Experiment in vitro and ex vivo.</p><p><strong>Methods: </strong>The effect of erastin on the cell survival of nucleus pulposus cells was evaluated in fetal bovine serum (FBS) and glucose deprivation condition. RSL3 and ferrostatin-1 were applied to illustrate whether the effect of erastin is ferroptosis dependent. The involvement of solute carrier family 7, membrane 11(SLC7A11), autophagy as well as mechanistic target of rapamycin kinase complex 1(mTORC1) and transcription factor EB (TFEB) were assessed to demonstrate the working mechanism of erastin.</p><p><strong>Results: </strong>Erastin may induce cell death at the concentration of ≥ 5μM; however, it may protect nucleus pulposus cells against nutrient deprivation induced cell death at lower concentration (0.25-1μM) and the effect of erastin is ferroptosis independent. The mechanism study showed that the effect of erastin may relate to its SCL7A11 regulation, as SCL7A11 knock-down may have the similar effect as erastin. Furthermore, it was also demonstrated that mTORC1-TFEB mediated autophagy was involved in protective effect of erastin.</p><p><strong>Conclusions: </strong>Low dose erastin may promote cell survival under nutrient deprivation condition, and its effect is ferroptosis independent; erastin may exert its protective effect through mTORC1-TFEB mediated autophagy regulation.</p><p><strong>Clinical significance: </strong>Nutrient deprivation is a major contributor to intervertebral disc degeneration. Our in vitro and ex vivo study showed that low dose of erastin may suppress nutrient deprivation induced cell death in IVD degeneration. Although it was not validated in vivo model due to lack of in vivo nutrient deprivation induced IVD degeneration model currently, this study may still provide a potential therapeutic option for IVD degeneration, which of cause need further validation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A \"people-like-me\" approach to predict individual recovery following lumbar microdiscectomy and physical therapy for lumbar radiculopathy.","authors":"Stijn J Willems, Andrew J Kittelson, Servan Rooker, Martijn W Heymans, Thomas J Hoogeboom, Michel W Coppieters, Gwendolyne G M Scholten-Peeters","doi":"10.1016/j.spinee.2024.10.003","DOIUrl":"10.1016/j.spinee.2024.10.003","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar microdiscectomy is an effective treatment for short-term pain relief and improvements in disability in patients with lumbar radiculopathy, however, many patients experience residual pain and long-term disability. The 'people like me' approach seeks to enhance personalized prognosis and treatment effectiveness, utilizing historical data from similar patients to forecast individual outcomes.</p><p><strong>Purpose: </strong>The primary objective was to develop and test the 'people-like-me' approach for leg pain intensity and disability at 12-month follow-up after lumbar microdiscectomy and postoperative physical therapy. The secondary objective was to verify the clinical utility of the prediction tool via case vignettes.</p><p><strong>Study design/setting: </strong>A 12-month prospective cohort study.</p><p><strong>Patient sample: </strong>Patients (N=618, mean age: 44.7) with lumbar radiculopathy who undergo a lumbar microdiscectomy and postoperative physical therapy.</p><p><strong>Outcome measures: </strong>Leg pain intensity (Visual Analogue Scale) and disability (Roland-Morris Disability Questionnaire) were measured at 12-months following surgery.</p><p><strong>Methods: </strong>Predictors were selected from data collected in routine practice before and 3-months after lumbar microdiscectomy. Predictive mean matching was used to select matches. Predictions were developed using preoperative data alone or combined with 3-month postoperative data. The prediction performance was evaluated for bias (difference between predicted and actual outcomes), coverage (proportion of actual outcomes within prediction intervals), and precision (accuracy of predictions) using leave-one-out cross-validation.</p><p><strong>Results: </strong>Overall, the 'people-like-me' approach using preoperative data showed accurate coverage and minimal average bias. However, precision based on preoperative data alone was limited. Incorporating 3-month postoperative data alongside preoperative predictors significantly enhanced prognostic precision for both leg pain and disability. Including postoperative data, leg pain prediction accuracy improved by 43% and disability by 23% compared to the sample mean. Adjusted R² values improved from 0.04 to 0.21 for leg pain, and from 0.07 to 0.34 for disability, enhancing model precision. The effectiveness of this method was highlighted in two case vignettes, illustrating its application in similar patient scenarios.</p><p><strong>Conclusion: </strong>The 'people-like-me' approach generated an accurate prognosis of 12-months outcomes following lumbar discectomy and physical therapy. Scheduling a 3-month postoperative follow-up to evaluate the course, and refine therapy plans and expectations for patients undergoing lumbar microdiscectomy would be recommended to assist clinicians and patients in more personalized healthcare planning and expectation setting.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Civilian ballistic spinal cord injuries versus blunt trauma: comparative analysis of clinical characteristics, management, and outcomes.","authors":"Alina Jacob, Markus Loibl, Stefan Kruger, Benjamin H Blankson, Ivan Zderic, Christian R Wirtz, Robert N Dunn, Nicholas A Kruger","doi":"10.1016/j.spinee.2024.10.006","DOIUrl":"10.1016/j.spinee.2024.10.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;There are no current guidelines for the management of civilian gunshot wound injuries (GSW) to the spine and patient management often relies on algorithms derived from blunt trauma (BT). However, spinal cord injury due to GSW or blunt trauma mechanism may have significantly different clinical presentation, management, and outcomes. To ensure improved and evidence-based treatment, we need to understand the outcome determining characteristics of civilian GSW to the spine and identify the differences to the well-studied BT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aim of this study was to compare clinical characteristics, neurological deficit, management strategies, and mortality associated with GSW to the spine versus BT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective single-center analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;One thousand nine hundred thirty-nine unique patients admitted to a level 1 trauma center with spinal cord injuries due to GSW or BT between the years 2003-2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Primary outcome measure was the progression in American Spinal Injury Association (ASIA) motor score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical characteristics were compared followed by age-matched analysis (&lt;45years) of neurological injury, the need for surgery, neurological outcomes and mortality. Stratification by neurological injury allowed for more homogenous subgroups for outcome analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 1939 patients with spinal cord injury, 566 were included in GSW group, and 1373 patients in BT group. Most patients in the GSW group were males (94.9% GSW vs. 83.5% BT; p&lt;.001) and younger (28.2 (range 13-62) years vs. 37.9, (range 12-91) years, p&lt;.001). The age-matched dataset comprised 1536 patients, with 540 in GSW group, and 996 in BT group. There were significantly more complete neurological injuries at admission in GSW group compared with BT (63.5% GSW vs. 34.4% BT, p&lt;.001). The ASIA motor Score at admission was significantly lower in GSW group (p&lt;.001), and changed without significant difference between the groups from admission to discharge (p&lt;.001, p=.222). Subgroup analysis based on spinal cord injury showed that a higher proportion of patients with incomplete injuries improved neurologically, opposed to complete injuries, with significantly more patients improving in GSW group compared to BT (incomplete 58.9% GSW vs. 44.3% BT, p&lt;.001). Likewise, a higher proportion of paraplegic patients improved, opposed to quadriplegic patients, and in the paraplegic subgroup GSW patients improved rather than BT (paraplegic 65.1% GSW vs. 35.3%BT, p&lt;.001). In GSW group significantly less patients were managed operatively compared to BT group (12.2% GSW vs 76.8% BT, p&lt;.001). Most surgeries were bullet removals (81,4%) and involved the lumbar spine: 38.6% lumbar surgeries (of all GSW surgeries) and 31.4% surgery rate of all lumbar GSW patients. There was no significant ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-wide methylation association study in monozygotic twins discordant for curve severity of adolescent idiopathic scoliosis.","authors":"Zhichong Wu, Zhicheng Dai, Zhenhua Feng, Yong Qiu, Zezhang Zhu, Leilei Xu","doi":"10.1016/j.spinee.2024.10.015","DOIUrl":"10.1016/j.spinee.2024.10.015","url":null,"abstract":"<p><strong>Background context: </strong>Emerging evidence suggests that abnormal DNA methylation patterns may play a role in the progression of adolescent idiopathic scoliosis (AIS). However, the mechanisms underlying the influence of DNA methylation on curve severity remain largely unknown.</p><p><strong>Purpose: </strong>To characterize the DNA methylation profiles associated with the curve severity of AIS.</p><p><strong>Study design: </strong>Retrospective study with prospectively collected clinical data and blood samples.</p><p><strong>Methods: </strong>A total of 7 AIS monozygotic twin pairs discordant for curve severity were included. Genome-wide methylation profile from blood samples were quantified by Illumina Infinium MethylationEPIC BeadChip (850K chip). Cell type composition of the samples was estimated by RefbaseEWAS method. Differentially methylated CpG sites were identified through comparison between patients with low and high Cobb angle. We also performed a gene-based collapsing analysis using mCSEA by aggregating the CpG sites based on promoter region. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed using clusterProfiler package.</p><p><strong>Results: </strong>Genome-wide DNA methylation analysis identified multiple differentially methylated positions across the genome. Gene-based collapsing analysis identified 212 differentially methylated genes (FDR adjusted p<.05), most of which (186/212) were hypermethylated in the group with high Cobb angle. Some of the identified genes were well-documented in AIS literature, such as TBX1, PAX3 and LBX1. Functional enrichment analysis revealed that the differentially methylated genes (DMGs) were involved in pattern specification process, skeletal development, muscle function, neurotransmission and several signaling pathways (cAMP, Wnt and prolactin).</p><p><strong>Conclusions: </strong>The study represents the largest systematic epigenomic analyses of monozygotic twins discordant for curve severity and supports the important role of altered DNA methylation in AIS.</p><p><strong>Clinical significance: </strong>The identified CpG sites provide insight into novel biomarkers predicting curve progression of AIS. Furthermore, the differentially methylated genes and enriched pathways may serve as interventional therapy target for AIS patients.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low pelvic incidence as a risk factor for vertebral recollapse after percutaneous vertebroplasty in the thoracolumbar region.","authors":"Xiaofei Cheng, Xin Sun, Kai Zhang, Xiaojiang Sun, Yue Xu, Changqing Zhao, Jie Zhao","doi":"10.1016/j.spinee.2024.10.012","DOIUrl":"10.1016/j.spinee.2024.10.012","url":null,"abstract":"<p><strong>Background context: </strong>Percutaneous vertebroplasty (PVP) is an effective procedure for treatment of osteoporotic vertebral compression fractures (OVCFs). Recollapse of the cemented vertebrae is not unusual and the thoracolumbar junction is the most common region. Nevertheless, not all patients suffering from OVCFs in this region develop recollapse after PVP.</p><p><strong>Purpose: </strong>The aim of this study was to investigate possible risk factors related to recollapse of the cemented vertebrae in the thoracolumbar region.</p><p><strong>Study design/setting: </strong>Retrospective study.</p><p><strong>Patient sample: </strong>A total of 161 patients undergoing PVP.</p><p><strong>Outcome measures: </strong>Clinical outcomes were assessed using Visual Analog Scale (VAS) scores. Radiographic parameters included pelvic incidence (PI), thoracolumbar kyphosis (TLK), kyphotic angle, compression rate, reduction rate, and occurrence of intravertebral cleft (IVC).</p><p><strong>Methods: </strong>Patients were divided into the recollapse group and control group. Patient characteristics, clinical and radiographic parameters were compared between the two groups. Univariate and multivariate logistic regression were used to evaluate the potential risk factors for recollapse. The correlations between the variables were examined. A receiver operating characteristic curve of PI was constructed to discriminate between patients with and without recollapse.</p><p><strong>Results: </strong>There were no significant differences in patient characteristics between the two groups except for bone mineral density (BMD). Occurrence rate of IVC was significantly higher in the recollapse group. VAS scores were significantly decreased after PVP. At last follow-up, they were increased in the recollapse group and maintained in the control group. PI was significantly lower in the recollapse group than in the control group. The univariate logistic regression found four possible risk factors for recollapse, including low PI, IVC, low BMD, and high TLK. Further multivariate logistic regression eliminated high TLK from them. The collinear analysis showed low tolerance and high variance inflation factor for preoperative and postoperative TLK, but not for PI, IVC and BMD. PI was a good predictor of recollapse, and the optimal cut-off value was 43°. The magnitude of preoperative and postoperative TLK was significantly correlated with the value of PI.</p><p><strong>Conclusions: </strong>Recollapse of the cemented vertebrae in the thoracolumbar region was related to low PI, IVC and low BMD. PI less than 43° was a good predictor of recollapse. TLK was dependent on PI and not a risk factor for recollapse. In addition to PVP, patients with low PI, IVC and low BMD may require personalized interventions such as combined internal fixation and trunk orthoses.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence, providers involved, and patient factors associated with diagnosis of specific lumbar spine pathology subsequent an initial nonspecific low back pain diagnosis.","authors":"Anthony E Seddio, Sahir S Jabbouri, Michael J Gouzoulis, Joshua G Sanchez, Wesley Day, Arya G Varthi, Daniel R Rubio, Jonathan N Grauer","doi":"10.1016/j.spinee.2024.10.008","DOIUrl":"10.1016/j.spinee.2024.10.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Low back pain (LBP) is an exceedingly common diagnosis with significant societal and healthcare burden. While nonspecific LBP diagnoses are frequently assigned and often resolve soon thereafter, some patients may subsequently be diagnosed with specific underlying lumbar spine pathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To characterize the incidence, providers involved, and factors associated with specific pathology LBP (SP-LBP) diagnosed subsequent an initial nonspecific LBP (NS-LBP) diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adult patients diagnosed with NS-LBP between 2010 and Q1 2022 were abstracted from a large national administrative database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measurements: &lt;/strong&gt;Incidence of subsequent SP-LBP diagnoses, providers involved, and factors associated with SP-LBP diagnoses in the 12-months following initial NS-LBP diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Adult patients diagnosed with NS-LBP were identified based on International Classification of Disease (ICD) codes ICD-9-D-724.2 and ICD-10-D-M54.5. These patients diagnosed with new NS-LBP were reported based on incidence per 100,000 covered lives. Exclusion criteria included: patients less than 18 years old, those with any prior NS-LBP diagnosis, any prior SP-LBP diagnoses, and those with trauma, neoplasm, or infection diagnosed within 3-months prior to the initial NS-LBP diagnosis. Patients who subsequently received SP-LBP diagnoses within 12-months following initial NS-LBP were then identified. Patients were characterized based on age, sex, history of cancer, obesity, opioid use disorder, anxiety, and depression and then compared with patients receiving no additional LBP diagnosis by univariable and multivariable analysis. Provider specialties who initially diagnosed NS-LBP and those involved with subsequent SP-LBP diagnoses were identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;NS-LBP was identified for a robust cohort of 6,861,235 patients, yielding an incidence of 4,258 diagnoses per 100,000 covered lives. Subsequent SP-LBP diagnoses were identified for 562,982 (8.21%) within 12-months, of which 62.57% of these SP-LBP diagnoses occurred within 3-months. The most common of these subsequent diagnoses included radiculopathy (3.01% of the overall study population), disc degeneration (2.84%), and disc herniation (1.23%). Patients receiving a subsequent SP-LBP diagnosis were more likely older (per year increase, odds ratio [OR] 1.02), male (OR 1.10), had a history of cancer (OR 1.32), obesity (OR 1.30), opioid use disorder (OR 1.17), anxiety (OR 1.21), or depression (OR 1.17) (p&lt;.001 for all). NS-LBP was initially diagnosed predominantly by primary care providers (PCPs) in family medicine (44.09%) and internal medicine (27.49%). These PCP providers also contributed to the majority of SP-LBP diagnoses, while specialty providers contributed to a greater degree in SP-LB","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-segment fusion versus isolated decompression in lumbar spinal canal stenosis patients with Cobb angles over 20 degrees.","authors":"Tomoyuki Asada, Chad Z Simon, Atahan Durbas, Myles R J Allen, Kevin J DiSilvestro, Takashi Hirase, Nishtha Singh, Patawut Bovonratwet, Annika Bay, Tejas Subramanian, Eric Mai, Yeo Eun Kim, Maximillian K Korsun, Olivia C Tuma, Kasra Araghi, Joshua Zhang, Eric T Kim, Cole T Kwas, Amy Z Lu, Avani S Vaishnav, James E Dowdell, Evan D Sheha, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2024.10.007","DOIUrl":"10.1016/j.spinee.2024.10.007","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar decompression and short-segment lumbar fusion are standard procedures for short-segment lumbar canal stenosis, even in patients with moderate Cobb angles. Adult degenerative scoliosis is diagnosed at a threshold of 10 degrees, and patients with coronal Cobb angles over 30 degrees are recommended for long fusion due to global spinal deformity. However, there is a lack of research on clinical outcomes in patients with moderate coronal deformity, such as Cobb angles between 20 and 30 degrees.</p><p><strong>Purpose: </strong>This study aims to investigate the radiographic and clinical outcome differences between isolated decompression and short-segment interbody fusion for lumbar spinal canal stenosis in patients with moderate coronal deformity.</p><p><strong>Study design: </strong>A retrospective analysis of a prospectively collected registry.</p><p><strong>Patient sample: </strong>Patients with Cobb angle exceeding 20 degrees who underwent 1- or 2- levels of lumbar surgery for lumbar canal stenosis. Patients diagnosed as spinal deformity were excluded.</p><p><strong>Outcome measures: </strong>Patient-reported outcomes included Oswestry Disability Index (ODI), VAS back, VAS leg, Short form 12 physical component score (SF-12 PCS) and Mental Component Score (SF-12 MCS), and patient-reported outcomes measurement information system physical function (PROMIS-PF) at preoperative, 12-week postoperative, and 1-year postoperative timepoints. Preoperative and postoperative spinopelvic alignment was assessed using Cobb angle, pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis and PI minus LL.</p><p><strong>Methods: </strong>A propensity score-matched analysis with the overlap weighting was utilized to investigate patient-reported outcomes at 12-week and 1-year postoperatively between the surgery groups. Spinopelvic alignments were compared between preoperative and 1-year postoperative timepoint using a linear mixed-effect model.</p><p><strong>Results: </strong>Before overlap weighting, the two surgery groups showed significant differences in age and diagnosis. No obvious sagittal malalignment was observed (PI minus LL: decompression, 7.4° vs. fusion, 11.5°). After propensity score weighting, the fusion groups exhibited significantly better ODI and VAS back at the 1-year timepoint (ODI: fusion, 16.6 vs. decompression, 28.1, p=.013; VAS back: fusion, 1.5±2.1 vs. decompression, 3.7±1.9, p<.001). Radiographic assessment showed that the fusion group achieved better PI minus LL compared to decompression group (15° vs. 10°, p=.008).</p><p><strong>Conclusion: </strong>In patients with degenerative scoliosis and a Cobb angle greater than 20 degrees, short-segment lumbar fusion surgery may result in enhanced improvement for short-segment lumbar pathology compared to isolated decompression.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}